NEW ERA UNIVERSITY

College of Nursing

CONAP 18 ANATOMY & PHYSIOLOGY LECTURE

First Semester, AY 2020-2021

MODULE 4: The Integumentary System

Introduction
What do you think when you look at your skin in the mirror? Do you think
about covering it with makeup, adding a tattoo, or maybe a body piercing? Or do
you think about the fact that the skin belongs to one of the body’s most essential
and dynamic systems: the integumentary system? The integumentary system
refers to the skin and its accessory structures, and it is responsible for much more
than simply lending to your outward appearance. In the adult human body, the skin
makes up about 16 percent of body weight and covers an area of 1.5 to 2 m 2. In
fact, the skin and accessory structures are the largest organ system in the human
body. As such, the skin protects your inner organs and it is in need of daily care
and protection to maintain its health. This module will introduce the structure and
functions of the integumentary system, as well as some of the diseases, disorders,
and injuries that can affect this system.

Learning Outcomes:

After completion of this lesson, the student will be able to:

1. Describe the integumentary system and the role it plays in homeostasis

2. Describe the layers of the skin and the functions of each layer
3. Describe the accessory structures of the skin and the functions of each
4. Describe the changes that occur in the integumentary system during the
aging process
5. Discuss several common diseases, disorders, and injuries that affect the
integumentary system
6. Explain treatments for some common diseases, disorders, and injuries of
the integumentary system

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Key Terms

acne
skin condition due to infected sebaceous glands
albinism
genetic disorder that affects the skin, in which there is no melanin
production
anagen
active phase of the hair growth cycle
apocrine sweat gland
type of sweat gland that is associated with hair follicles in the armpits and
genital regions
arrector pili
smooth muscle that is activated in response to external stimuli that pull on
hair follicles and make the hair “stand up”
basal cell
type of stem cell found in the stratum basale and in the hair matrix that
continually undergoes cell division, producing the keratinocytes of the
epidermis
basal cell carcinoma
cancer that originates from basal cells in the epidermis of the skin
bedsore
sore on the skin that develops when regions of the body start necrotizing
due to constant pressure and lack of blood supply; also called decubitis
ulcers
callus
thickened area of skin that arises due to constant abrasion
catagen
transitional phase marking the end of the anagen phase of the hair growth
cycle
corn
type of callus that is named for its shape and the elliptical motion of the
abrasive force
cortex
in hair, the second or middle layer of keratinocytes originating from the
hair matrix, as seen in a cross-section of the hair bulb
cuticle
in hair, the outermost layer of keratinocytes originating from the hair
matrix, as seen in a cross-section of the hair bulb

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dermal papilla
(plural = dermal papillae) extension of the papillary layer of the dermis that
increases surface contact between the epidermis and dermis
dermis
layer of skin between the epidermis and hypodermis, composed mainly of
connective tissue and containing blood vessels, hair follicles, sweat
glands, and other structures
desmosome
structure that forms an impermeable junction between cells
eccrine sweat gland
type of sweat gland that is common throughout the skin surface; it
produces a hypotonic sweat for thermoregulation
eczema
skin condition due to an allergic reaction, which resembles a rash
elastin fibers
fibers made of the protein elastin that increase the elasticity of the dermis
eleiden
clear protein-bound lipid found in the stratum lucidum that is derived from
keratohyalin and helps to prevent water loss
epidermis
outermost tissue layer of the skin
eponychium
nail fold that meets the proximal end of the nail body, also called the
cuticle
external root sheath
outer layer of the hair follicle that is an extension of the epidermis, which
encloses the hair root
first-degree burn
superficial burn that injures only the epidermis
fourth-degree burn
burn in which full thickness of the skin and underlying muscle and bone is
damaged
glassy membrane
layer of connective tissue that surrounds the base of the hair follicle,
connecting it to the dermis
hair
keratinous filament growing out of the epidermis
hair bulb
structure at the base of the hair root that surrounds the dermal papilla

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hair follicle
cavity or sac from which hair originates
hair matrix
layer of basal cells from which a strand of hair grows
hair papilla
mass of connective tissue, blood capillaries, and nerve endings at the
base of the hair follicle
hair root
part of hair that is below the epidermis anchored to the follicle
hair shaft
part of hair that is above the epidermis but is not anchored to the follicle
hypodermis
connective tissue connecting the integument to the underlying bone and
muscle
hyponychium
thickened layer of stratum corneum that lies below the free edge of the
nail
integumentary system
skin and its accessory structures
internal root sheath
innermost layer of keratinocytes in the hair follicle that surround the hair
root up to the hair shaft
keloid
type of scar that has layers raised above the skin surface
keratin
type of structural protein that gives skin, hair, and nails its hard, water-
resistant properties
keratinocyte
cell that produces keratin and is the most predominant type of cell found in
the epidermis
keratohyalin
granulated protein found in the stratum granulosum
Langerhans cell
specialized dendritic cell found in the stratum spinosum that functions as a
macrophage
lunula
basal part of the nail body that consists of a crescent-shaped layer of thick
epithelium
medulla

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 in hair, the innermost layer of keratinocytes originating from the hair matrix
Meissner corpuscle
(also, tactile corpuscle) receptor in the skin that responds to light touch
melanin
pigment that determines the color of hair and skin
melanocyte
cell found in the stratum basale of the epidermis that produces the
pigment melanin
melanoma
type of skin cancer that originates from the melanocytes of the skin
melanosome
intercellular vesicle that transfers melanin from melanocytes into
keratinocytes of the epidermis
Merkel cell
receptor cell in the stratum basale of the epidermis that responds to the
sense of touch
metastasis
spread of cancer cells from a source to other parts of the body
nail bed
layer of epidermis upon which the nail body forms
nail body
main keratinous plate that forms the nail
nail cuticle
fold of epithelium that extends over the nail bed, also called the
eponychium
nail fold
fold of epithelium at that extend over the sides of the nail body, holding it
in place
nail root
part of the nail that is lodged deep in the epidermis from which the nail
grows
Pacinian corpuscle
(also, lamellated corpuscle) receptor in the skin that responds to vibration
papillary layer
superficial layer of the dermis, made of loose, areolar connective tissue
reticular layer
deeper layer of the dermis; it has a reticulated appearance due to the
presence of abundant collagen and elastin fibers
rickets

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 disease in children caused by vitamin D deficiency, which leads to the
weakening of bones
scar
collagen-rich skin formed after the process of wound healing that is
different from normal skin
sebaceous gland
type of oil gland found in the dermis all over the body and helps to
lubricate and waterproof the skin and hair by secreting sebum
sebum
oily substance that is composed of a mixture of lipids that lubricates the
skin and hair
second-degree burn
partial-thickness burn that injures the epidermis and a portion of the
dermis
squamous cell carcinoma
type of skin cancer that originates from the stratum spinosum of the
epidermis
stratum basale
deepest layer of the epidermis, made of epidermal stem cells
stratum corneum
most superficial layer of the epidermis
stratum granulosum
layer of the epidermis superficial to the stratum spinosum
stratum lucidum
layer of the epidermis between the stratum granulosum and stratum
corneum, found only in thick skin covering the palms, soles of the feet,
and digits
stratum spinosum
layer of the epidermis superficial to the stratum basale, characterized by
the presence of desmosomes
stretch mark
mark formed on the skin due to a sudden growth spurt and expansion of
the dermis beyond its elastic limits
sudoriferous gland
sweat gland
telogen
resting phase of the hair growth cycle initiated with catagen and
terminated by the beginning of a new anagen phase of hair growth
third-degree burn

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 burn that penetrates and destroys the full thickness of the skin (epidermis
and dermis)
vitamin D
compound that aids absorption of calcium and phosphates in the intestine
to improve bone health
vitiligo
skin condition in which melanocytes in certain areas lose the ability to
produce melanin, possibly due an autoimmune reaction that leads to loss
of color in patches

Lesson 1: Functions of the Skin

Learning Outcomes:

After completion of this lesson, the student will be able to:

1. Describe the different functions of the skin and the structures that enable
them.
2. Explain how the skin helps maintain body temperature.

Overview
The skin and accessory structures perform a variety of essential functions,
such as protecting the body from invasion by microorganisms, chemicals, and
other environmental factors; preventing dehydration; acting as a sensory organ;
modulating body temperature and electrolyte balance; and synthesizing vitamin D.
The underlying hypodermis has important roles in storing fats, forming a “cushion”
over underlying structures, and providing insulation from cold temperatures . This
lesson will explain the numerous functions of the skin.

Functions of the Skin

Protection

The skin protects the rest of the body from the basic elements of nature
such as wind, water, and UV sunlight. It acts as a protective barrier against water
loss, due to the presence of layers of keratin and glycolipids in the stratum
corneum. It also is the first line of defense against abrasive activity due to contact
with grit, microbes, or harmful chemicals. Sweat excreted from sweat glands deters

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microbes from over-colonizing the skin surface by generating dermicidin, which
has antibiotic properties.

Sensory Function

The fact that you can feel an ant crawling on your skin, allowing you to flick
it off before it bites, is because the skin, and especially the hairs projecting from
hair follicles in the skin, can sense changes in the environment. The hair root
plexus surrounding the base of the hair follicle senses a disturbance, and then
transmits the information to the central nervous system (brain and spinal cord),
which can then respond by activating the skeletal muscles of your eyes to see the
ant and the skeletal muscles of the body to act against the ant.

The skin acts as a sense organ because the epidermis, dermis, and the
hypodermis contain specialized sensory nerve structures that detect touch,
surface temperature, and pain. These receptors are more concentrated on the tips
of the fingers, which are most sensitive to touch, especially the Meissner
corpuscle (tactile corpuscle) (Figure 4.1), which responds to light touch, and
the Pacinian corpuscle (lamellated corpuscle), which responds to vibration.
Merkel cells, seen scattered in the stratum basale, are also touch receptors. In
addition to these specialized receptors, there are sensory nerves connected to
each hair follicle, pain and temperature receptors scattered throughout the skin,
and motor nerves innervate the arrector pili muscles and glands. This rich
innervation helps us sense our environment and react accordingly.

Figure 4.1 Light Micrograph of a Meissner Corpuscle In this micrograph of a skin cross-section,
you can see a Meissner corpuscle (arrow), a type of touch receptor located in a dermal papilla
adjacent to the basement membrane and stratum basale of the overlying epidermis. LM × 100.
(credit: “Wbensmith”/Wikimedia Commons)

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Thermoregulation

The integumentary system helps regulate body temperature through its tight
association with the sympathetic nervous system, the division of the nervous
system involved in our fight-or-flight responses. The sympathetic nervous system
is continuously monitoring body temperature and initiating appropriate motor
responses. Recall that sweat glands, accessory structures to the skin, secrete
water, salt, and other substances to cool the body when it becomes warm. Even
when the body does not appear to be noticeably sweating, approximately 500 mL
of sweat (insensible perspiration) are secreted a day. If the body becomes
excessively warm due to high temperatures, vigorous activity (Figure 4.2 ac), or a
combination of the two, sweat glands will be stimulated by the sympathetic nervous
system to produce large amounts of sweat, as much as 0.7 to 1.5 L per hour for
an active person. When the sweat evaporates from the skin surface, the body is
cooled as body heat is dissipated.

In addition to sweating, arterioles in the dermis dilate so that excess heat carried
by the blood can dissipate through the skin and into the surrounding environment
(Figure 4.2b). This accounts for the skin redness that many people experience
when exercising.

Figure 4.2 Thermoregulation During strenuous physical activities, such as skiing (a) or running
(c), the dermal blood vessels dilate and sweat secretion increases (b). These mechanisms prevent
the body from overheating. In contrast, the dermal blood vessels constrict to minimize heat loss in
response to low temperatures (b). (credit a: “Trysil”/flickr; credit c: Ralph Daily)

When body temperatures drop, the arterioles constrict to minimize heat

loss, particularly in the ends of the digits and tip of the nose. This reduced
circulation can result in the skin taking on a whitish hue. Although the temperature
of the skin drops as a result, passive heat loss is prevented, and internal organs
and structures remain warm. If the temperature of the skin drops too much (such
as environmental temperatures below freezing), the conservation of body core
heat can result in the skin actually freezing, a condition called frostbite.

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Vitamin D Synthesis

The epidermal layer of human skin synthesizes vitamin D when exposed

to UV radiation. In the presence of sunlight, a form of vitamin D 3 called
cholecalciferol is synthesized from a derivative of the steroid cholesterol in the skin.
The liver converts cholecalciferol to calcidiol, which is then converted to calcitriol
(the active chemical form of the vitamin) in the kidneys. Vitamin D is essential for
normal absorption of calcium and phosphorous, which are required for healthy
bones. The absence of sun exposure can lead to a lack of vitamin D in the body,
leading to a condition called rickets, a painful condition in children where the
bones are misshapen due to a lack of calcium, causing bowleggedness. Elderly
individuals who suffer from vitamin D deficiency can develop a condition called
osteomalacia, a softening of the bones. In present day society, vitamin D is added
as a supplement to many foods, including milk and orange juice, compensating for
the need for sun exposure.

In addition to its essential role in bone health, vitamin D is essential for

general immunity against bacterial, viral, and fungal infections. Recent studies are
also finding a link between insufficient vitamin D and cancer.

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 Lesson 2: Layers of the Skin

Learning Outcomes:
After completion of this lesson, the student will be able to:

1. Identify the components of the integumentary system.

2. Describe the layers of the skin and the functions of each layer.
3. Identify and describe the hypodermis and deep fascia.
4. Describe the role of keratinocytes and their life cycle.
5. Describe the role of melanocytes in skin pigmentation.

Overview
Although you may not typically think of the skin as an organ, it is in fact
made of tissues that work together as a single structure to perform unique and
critical functions. The skin and its accessory structures make up
the integumentary system, which provides the body with overall protection. The
skin is made of multiple layers of cells and tissues, which are held to underlying
structures by connective tissue (Figure 4.3). The deeper layer of skin is well
vascularized (has numerous blood vessels). It also has numerous sensory, and
autonomic and sympathetic nerve fibers ensuring communication to and from the
brain. This lesson will illustrate the different layers of the skin.

Figure 4.3 Layers of Skin The skin is composed of two main layers: the epidermis, made of
closely packed epithelial cells, and the dermis, made of dense, irregular connective tissue that
houses blood vessels, hair follicles, sweat glands, and other structures. Beneath the dermis lies
the hypodermis, which is composed mainly of loose connective and fatty tissues.

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The Epidermis

The epidermis is composed of keratinized, stratified squamous epithelium.

It is made of four or five layers of epithelial cells, depending on its location in the
body. It does not have any blood vessels within it (i.e., it is avascular). Skin that
has four layers of cells is referred to as “thin skin.” From deep to superficial, these
layers are the stratum basale, stratum spinosum, stratum granulosum, and stratum
corneum. Most of the skin can be classified as thin skin. “Thick skin” is found only
on the palms of the hands and the soles of the feet. It has a fifth layer, called the
stratum lucidum, located between the stratum corneum and the stratum
granulosum (Figure 4.4).

Figure 4.4 Thin Skin versus Thick Skin These slides show cross-sections of the epidermis and
dermis of (a) thin and (b) thick skin. Note the significant difference in the thickness of the epithelial
layer of the thick skin. From top, LM × 40, LM × 40. (Micrographs provided by the Regents of
University of Michigan Medical School © 2012)

The cells in all of the layers except the stratum basale are called
keratinocytes. A keratinocyte is a cell that manufactures and stores the protein
keratin. Keratin is an intracellular fibrous protein that gives hair, nails, and skin
their hardness and water-resistant properties. The keratinocytes in the stratum
corneum are dead and regularly slough away, being replaced by cells from the
deeper layers (Figure 4.5).

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Figure 4.5 Epidermis The epidermis is epithelium composed of multiple layers of cells. The basal
layer consists of cuboidal cells, whereas the outer layers are squamous, keratinized cells, so the
whole epithelium is often described as being keratinized stratified squamous epithelium. LM × 40.
(Micrograph provided by the Regents of University of Michigan Medical School © 2012.

Stratum Basale

The stratum basale (also called the stratum germinativum) is the deepest
epidermal layer and attaches the epidermis to the basal lamina, below which lie
the layers of the dermis. The cells in the stratum basale bond to the dermis via
intertwining collagen fibers, referred to as the basement membrane. A finger-like
projection, or fold, known as the dermal papilla (plural = dermal papillae) is found
in the superficial portion of the dermis. Dermal papillae increase the strength of the
connection between the epidermis and dermis; the greater the folding, the stronger
the connections made (Figure 4.6).

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Figure 4.6 Layers of the Epidermis The epidermis of thick skin has five layers: stratum basale,
stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.

The stratum basale is a single layer of cells primarily made of basal cells.
A basal cell is a cuboidal-shaped stem cell that is a precursor of the keratinocytes
of the epidermis. All of the keratinocytes are produced from this single layer of
cells, which are constantly going through mitosis to produce new cells. As new
cells are formed, the existing cells are pushed superficially away from the stratum
basale. Two other cell types are found dispersed among the basal cells in the
stratum basale. The first is a Merkel cell, which functions as a receptor and is
responsible for stimulating sensory nerves that the brain perceives as touch. These
cells are especially abundant on the surfaces of the hands and feet. The second
is a melanocyte, a cell that produces the pigment melanin. Melanin gives hair and
skin its color, and also helps protect the living cells of the epidermis from ultraviolet
(UV) radiation damage.

In a growing fetus, fingerprints form where the cells of the stratum basale
meet the papillae of the underlying dermal layer (papillary layer), resulting in the
formation of the ridges on your fingers that you recognize as fingerprints.
Fingerprints are unique to each individual and are used for forensic analyses
because the patterns do not change with the growth and aging processes.

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Stratum Spinosum

As the name suggests, the stratum spinosum is spiny in appearance due to the
protruding cell processes that join the cells via a structure called a desmosome.
The desmosomes interlock with each other and strengthen the bond between the
cells. It is interesting to note that the “spiny” nature of this layer is an artifact of the
staining process. Unstained epidermis samples do not exhibit this characteristic
appearance. The stratum spinosum is composed of eight to 10 layers of
keratinocytes, formed as a result of cell division in the stratum basale (Figure 4.7).
Interspersed among the keratinocytes of this layer is a type of dendritic cell called
the Langerhans cell, which functions as a macrophage by engulfing bacteria,
foreign particles, and damaged cells that occur in this layer.

Figure 4.7 Cells of the Epidermis The cells in the different layers of the epidermis originate from
basal cells located in the stratum basale, yet the cells of each layer are distinctively different. EM ×
2700. (Micrograph provided by the Regents of University of Michigan Medical School © 2012)

The keratinocytes in the stratum spinosum begin the synthesis of keratin and
release a water-repelling glycolipid that helps prevent water loss from the body,
making the skin relatively waterproof. As new keratinocytes are produced atop the
stratum basale, the keratinocytes of the stratum spinosum are pushed into the
stratum granulosum.

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Stratum Granulosum

The stratum granulosum has a grainy appearance due to further changes to the
keratinocytes as they are pushed from the stratum spinosum. The cells (three to
five layers deep) become flatter, their cell membranes thicken, and they generate
large amounts of the proteins keratin, which is fibrous, and keratohyalin, which
accumulates as lamellar granules within the cells (see Figure 4.6). These two
proteins make up the bulk of the keratinocyte mass in the stratum granulosum and
give the layer its grainy appearance. The nuclei and other cell organelles
disintegrate as the cells die, leaving behind the keratin, keratohyalin, and cell
membranes that will form the stratum lucidum, the stratum corneum, and the
accessory structures of hair and nails.

Stratum Lucidum

The stratum lucidum is a smooth, seemingly translucent layer of the epidermis

located just above the stratum granulosum and below the stratum corneum. This
thin layer of cells is found only in the thick skin of the palms, soles, and digits. The
keratinocytes that compose the stratum lucidum are dead and flattened
(see Figure 4.6). These cells are densely packed with eleiden, a clear protein rich
in lipids, derived from keratohyalin, which gives these cells their transparent (i.e.,
lucid) appearance and provides a barrier to water.

Stratum Corneum

The stratum corneum is the most superficial layer of the epidermis and is the
layer exposed to the outside environment (see Figure 4.6). The increased
keratinization (also called cornification) of the cells in this layer gives it its name.
There are usually 15 to 30 layers of cells in the stratum corneum. This dry, dead
layer helps prevent the penetration of microbes and the dehydration of underlying
tissues, and provides a mechanical protection against abrasion for the more
delicate, underlying layers. Cells in this layer are shed periodically and are
replaced by cells pushed up from the stratum granulosum (or stratum lucidum in
the case of the palms and soles of feet). The entire layer is replaced during a period
of about 4 weeks. Cosmetic procedures, such as microdermabrasion, help remove
some of the dry, upper layer and aim to keep the skin looking “fresh” and healthy.

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Dermis

The dermis might be considered the “core” of the integumentary system (derma-
= “skin”), as distinct from the epidermis (epi- = “upon” or “over”) and hypodermis
(hypo- = “below”). It contains blood and lymph vessels, nerves, and other
structures, such as hair follicles and sweat glands. The dermis is made of two
layers of connective tissue that compose an interconnected mesh of elastin and
collagenous fibers, produced by fibroblasts (Figure 4.7).

Figure 4.7 Layers of the Dermis This stained slide shows the two components of the dermis—
the papillary layer and the reticular layer. Both are made of connective tissue with fibers of collagen
extending from one to the other, making the border between the two somewhat indistinct. The
dermal papillae extending into the epidermis belong to the papillary layer, whereas the dense
collagen fiber bundles below belong to the reticular layer. LM × 10. (credit: modification of work by
“kilbad”/Wikimedia Commons)

Papillary Layer

The papillary layer is made of loose, areolar connective tissue, which

means the collagen and elastin fibers of this layer form a loose mesh. This
superficial layer of the dermis projects into the stratum basale of the epidermis to
form finger-like dermal papillae (see Figure 4.7). Within the papillary layer are
fibroblasts, a small number of fat cells (adipocytes), and an abundance of small
blood vessels. In addition, the papillary layer contains phagocytes, defensive cells
that help fight bacteria or other infections that have breached the skin. This layer

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also contains lymphatic capillaries, nerve fibers, and touch receptors called the
Meissner corpuscles.

Reticular Layer

Underlying the papillary layer is the much thicker reticular layer, composed
of dense, irregular connective tissue. This layer is well vascularized and has a rich
sensory and sympathetic nerve supply. The reticular layer appears reticulated (net-
like) due to a tight meshwork of fibers. Elastin fibers provide some elasticity to the
skin, enabling movement. Collagen fibers provide structure and tensile strength,
with strands of collagen extending into both the papillary layer and the hypodermis.
In addition, collagen binds water to keep the skin hydrated. Collagen injections and
Retin-A creams help restore skin turgor by either introducing collagen externally or
stimulating blood flow and repair of the dermis, respectively.

Hypodermis

The hypodermis (also called the subcutaneous layer or superficial fascia)

is a layer directly below the dermis and serves to connect the skin to the underlying
fascia (fibrous tissue) of the bones and muscles. It is not strictly a part of the skin,
although the border between the hypodermis and dermis can be difficult to
distinguish. The hypodermis consists of well-vascularized, loose, areolar
connective tissue and adipose tissue, which functions as a mode of fat storage
and provides insulation and cushioning for the integument.

Pigmentation

The color of skin is influenced by a number of pigments, including melanin,

carotene, and hemoglobin. Recall that melanin is produced by cells called
melanocytes, which are found scattered throughout the stratum basale of the
epidermis. The melanin is transferred into the keratinocytes via a cellular vesicle
called a melanosome (Figure 4.8).

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Figure 4.8 Skin Pigmentation The relative coloration of the skin depends of the amount of
melanin produced by melanocytes in the stratum basale and taken up by keratinocytes.

Melanin occurs in two primary forms. Eumelanin exists as black and brown,
whereas pheomelanin provides a red color. Dark-skinned individuals produce
more melanin than those with pale skin. Exposure to the UV rays of the sun or a
tanning salon causes melanin to be manufactured and built up in keratinocytes, as
sun exposure stimulates keratinocytes to secrete chemicals that stimulate
melanocytes. The accumulation of melanin in keratinocytes results in the
darkening of the skin, or a tan. This increased melanin accumulation protects the
DNA of epidermal cells from UV ray damage and the breakdown of folic acid, a
nutrient necessary for our health and well-being. In contrast, too much melanin can
interfere with the production of vitamin D, an important nutrient involved in calcium
absorption. Thus, the amount of melanin present in our skin is dependent on a
balance between available sunlight and folic acid destruction, and protection from
UV radiation and vitamin D production.

It requires about 10 days after initial sun exposure for melanin synthesis to
peak, which is why pale-skinned individuals tend to suffer sunburns of the
epidermis initially. Dark-skinned individuals can also get sunburns, but are more

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protected than are pale-skinned individuals. Melanosomes are temporary
structures that are eventually destroyed by fusion with lysosomes; this fact, along
with melanin-filled keratinocytes in the stratum corneum sloughing off, makes
tanning impermanent.

Too much sun exposure can eventually lead to wrinkling due to the
destruction of the cellular structure of the skin, and in severe cases, can cause
sufficient DNA damage to result in skin cancer. When there is an irregular
accumulation of melanocytes in the skin, freckles appear. Moles are larger masses
of melanocytes, and although most are benign, they should be monitored for
changes that might indicate the presence of cancer (Figure 4.9).

Figure 4.9 Moles Moles range from benign accumulations of melanocytes to melanomas. These
structures populate the landscape of our skin. (credit: the National Cancer Institute).

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 Lesson 3: Accessory Structures of the Skin

Learning Outcomes:

After completion of this lesson, the student will be able to:

1. Identify the accessory structures of the skin.

2. Describe the structure and function of hair and nails.
3. Describe the structure and function of sweat glands and sebaceous glands.

Overview

This lesson will deal with accessory structures of the skin include hair, nails,
sweat glands, and sebaceous glands. These structures embryologically originate
from the epidermis and can extend down through the dermis into the hypodermis.

Hair

Hair is a keratinous filament growing out of the epidermis. It is primarily

made of dead, keratinized cells. Strands of hair originate in an epidermal
penetration of the dermis called the hair follicle. The hair shaft is the part of the
hair not anchored to the follicle, and much of this is exposed at the skin’s surface.
The rest of the hair, which is anchored in the follicle, lies below the surface of the
skin and is referred to as the hair root. The hair root ends deep in the dermis at
the hair bulb, and includes a layer of mitotically active basal cells called the hair
matrix. The hair bulb surrounds the hair papilla, which is made of connective
tissue and contains blood capillaries and nerve endings from the dermis (Figure
4.10).

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Figure 4.10 Hair Hair follicles originate in the epidermis and have many different parts.

Just as the basal layer of the epidermis forms the layers of epidermis that
get pushed to the surface as the dead skin on the surface sheds, the basal cells
of the hair bulb divide and push cells outward in the hair root and shaft as the hair
grows. The medulla forms the central core of the hair, which is surrounded by
the cortex, a layer of compressed, keratinized cells that is covered by an outer
layer of very hard, keratinized cells known as the cuticle. These layers are
depicted in a longitudinal cross-section of the hair follicle (Figure 4.11), although
not all hair has a medullary layer. Hair texture (straight, curly) is determined by the
shape and structure of the cortex, and to the extent that it is present, the medulla.
The shape and structure of these layers are, in turn, determined by the shape of
the hair follicle. Hair growth begins with the production of keratinocytes by the
basal cells of the hair bulb. As new cells are deposited at the hair bulb, the hair
shaft is pushed through the follicle toward the surface. Keratinization is completed
as the cells are pushed to the skin surface to form the shaft of hair that is externally
visible. The external hair is completely dead and composed entirely of keratin. For
this reason, our hair does not have sensation. Furthermore, you can cut your hair
or shave without damaging the hair structure because the cut is superficial. Most
chemical hair removers also act superficially; however, electrolysis and yanking
both attempt to destroy the hair bulb so hair cannot grow.

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Figure 4.11 Hair Follicle The slide shows a cross-section of a hair follicle. Basal cells of the hair
matrix in the center differentiate into cells of the inner root sheath. Basal cells at the base of the
hair root form the outer root sheath. LM × 4. (credit: modification of work by “kilbad”/Wikimedia
Commons)

The wall of the hair follicle is made of three concentric layers of cells. The
cells of the internal root sheath surround the root of the growing hair and extend
just up to the hair shaft. They are derived from the basal cells of the hair matrix.
The external root sheath, which is an extension of the epidermis, encloses the
hair root. It is made of basal cells at the base of the hair root and tends to be more
keratinous in the upper regions. The glassy membrane is a thick, clear connective
tissue sheath covering the hair root, connecting it to the tissue of the dermis.

Interactive Link:

The hair follicle is made of multiple layers of cells that form from basal cells in the
hair matrix and the hair root. Cells of the hair matrix divide and differentiate to form
the layers of the hair. Watch this video to learn more about hair follicles.
https://www.youtube.com/watch?v=aLY4EzDXwSM

Hair serves a variety of functions, including protection, sensory input,

thermoregulation, and communication. For example, hair on the head protects the
skull from the sun. The hair in the nose and ears, and around the eyes (eyelashes)
defends the body by trapping and excluding dust particles that may contain
allergens and microbes. Hair of the eyebrows prevents sweat and other particles
from dripping into and bothering the eyes. Hair also has a sensory function due to

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sensory innervation by a hair root plexus surrounding the base of each hair follicle.
Hair is extremely sensitive to air movement or other disturbances in the
environment, much more so than the skin surface. This feature is also useful for
the detection of the presence of insects or other potentially damaging substances
on the skin surface. Each hair root is connected to a smooth muscle called
the arrector pili that contracts in response to nerve signals from the sympathetic
nervous system, making the external hair shaft “stand up.” The primary purpose
for this is to trap a layer of air to add insulation. This is visible in humans as goose
bumps and even more obvious in animals, such as when a frightened cat raises
its fur. Of course, this is much more obvious in organisms with a heavier coat than
most humans, such as dogs and cats.

Hair Growth

Hair grows and is eventually shed and replaced by new hair. This occurs in three
phases. The first is the anagen phase, during which cells divide rapidly at the root
of the hair, pushing the hair shaft up and out. The length of this phase is measured
in years, typically from 2 to 7 years. The catagen phase lasts only 2 to 3 weeks,
and marks a transition from the hair follicle’s active growth. Finally, during
the telogen phase, the hair follicle is at rest and no new growth occurs. At the end
of this phase, which lasts about 2 to 4 months, another anagen phase begins. The
basal cells in the hair matrix then produce a new hair follicle, which pushes the old
hair out as the growth cycle repeats itself. Hair typically grows at the rate of 0.3
mm per day during the anagen phase. On average, 50 hairs are lost and replaced
per day. Hair loss occurs if there is more hair shed than what is replaced and can
happen due to hormonal or dietary changes. Hair loss can also result from the
aging process, or the influence of hormones.

Hair Color

Similar to the skin, hair gets its color from the pigment melanin, produced by
melanocytes in the hair papilla. Different hair color results from differences in the
type of melanin, which is genetically determined. As a person ages, the melanin
production decreases, and hair tends to lose its color and becomes gray and/or
white.

Nails

The nail bed is a specialized structure of the epidermis that is found at the tips of
our fingers and toes. The nail body is formed on the nail bed, and protects the
tips of our fingers and toes as they are the farthest extremities and the parts of the

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body that experience the maximum mechanical stress (Figure 4.12). In addition,
the nail body forms a back-support for picking up small objects with the fingers.
The nail body is composed of densely packed dead keratinocytes. The epidermis
in this part of the body has evolved a specialized structure upon which nails can
form. The nail body forms at the nail root, which has a matrix of proliferating cells
from the stratum basale that enables the nail to grow continuously. The lateral nail
fold overlaps the nail on the sides, helping to anchor the nail body. The nail fold
that meets the proximal end of the nail body forms the nail cuticle, also called
the eponychium. The nail bed is rich in blood vessels, making it appear pink,
except at the base, where a thick layer of epithelium over the nail matrix forms a
crescent-shaped region called the lunula (the “little moon”). The area beneath the
free edge of the nail, furthest from the cuticle, is called the hyponychium. It
consists of a thickened layer of stratum corneum.

Figure 4.12 Nails The nail is an accessory structure of the integumentary system.

Interactive Link:

Nails are accessory structures of the integumentary system. Visit this link to learn
more about the origin and growth of fingernails.
https://www.youtube.com/watch?v=TxZWOXgnt3A

Sweat Glands

When the body becomes warm, sudoriferous glands produce sweat to

cool the body. Sweat glands develop from epidermal projections into the dermis
and are classified as merocrine glands; that is, the secretions are excreted by
exocytosis through a duct without affecting the cells of the gland. There are two
types of sweat glands, each secreting slightly different products.

An eccrine sweat gland is type of gland that produces a hypotonic sweat

for thermoregulation. These glands are found all over the skin’s surface, but are
especially abundant on the palms of the hand, the soles of the feet, and the

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forehead (Figure 4.13). They are coiled glands lying deep in the dermis, with the
duct rising up to a pore on the skin surface, where the sweat is released. This type
of sweat, released by exocytosis, is hypotonic and composed mostly of water, with
some salt, antibodies, traces of metabolic waste, and dermicidin, an antimicrobial
peptide. Eccrine glands are a primary component of thermoregulation in humans
and thus help to maintain homeostasis.

Figure 4.13 Eccrine Gland Eccrine glands are coiled glands in the dermis that release sweat
that is mostly water.

An apocrine sweat gland is usually associated with hair follicles in densely

hairy areas, such as armpits and genital regions. Apocrine sweat glands are larger
than eccrine sweat glands and lie deeper in the dermis, sometimes even reaching
the hypodermis, with the duct normally emptying into the hair follicle. In addition to
water and salts, apocrine sweat includes organic compounds that make the sweat
thicker and subject to bacterial decomposition and subsequent smell. The release
of this sweat is under both nervous and hormonal control, and plays a role in the
poorly understood human pheromone response. Most commercial antiperspirants
use an aluminum-based compound as their primary active ingredient to stop
sweat. When the antiperspirant enters the sweat gland duct, the aluminum-based
compounds precipitate due to a change in pH and form a physical block in the
duct, which prevents sweat from coming out of the pore.

Sebaceous Glands

A sebaceous gland is a type of oil gland that is found all over the body and helps
to lubricate and waterproof the skin and hair. Most sebaceous glands are

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associated with hair follicles. They generate and excrete sebum, a mixture of
lipids, onto the skin surface, thereby naturally lubricating the dry and dead layer of
keratinized cells of the stratum corneum, keeping it pliable. The fatty acids of
sebum also have antibacterial properties, and prevent water loss from the skin in
low-humidity environments. The secretion of sebum is stimulated by hormones,
many of which do not become active until puberty. Thus, sebaceous glands are
relatively inactive during childhood.

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References

Books

Marieb, E., Keller, S. (2018), Essentials of Anatomy & Physiology, 12th

Edition, England: Pearson Education Limited.

Patton, K. (2013), Laboratory Manual: Essentials of Anatomy & Physiology,

Eighth Edition, McGraw-Hill Education.

Saladin, K., Gan, C., Cushman, H. (2018), Anatomy & Physiology: The Unity
of Form & Function, 8th Edition, New York: McGraw Hill Education.

Shier, D., Butler, J., Lewis, R. (2018), Hole’s Essentials of Human Anatomy &
Physiology, 13th Edition, New York: McGraw Hill Education.

Vanputte, C., Regan, J., Russo, A., & Seeley, R. (2019), Seeley’s Anatomy &
Physiology, 11th Edition, McGraw-Hill Education.

Tortora, G., Derrickson, B. (2014), Principles of Anatomy & Physiology, 14th

Edition, New Jersey: Wiley.

Online Resources
Rice University (2018, September 01). Anatomy & Physiology. Retrieved
September 20, 2020, from
https://opentextbc.ca/anatomyandphysiology/chapter/1-6-anatomical-
terminology/

Video Links
Modesto Jr. College (2008, December 22). Simple Skin Model: Hair Follicle.
Retrieved September 17, 2020 from
https://www.youtube.com/watch?v=aLY4EzDXwSM.

Izzo, Daniel (2007, August 3). Nail Growth. Retrieved September 18, 2020 from
https://www.youtube.com/watch?v=TxZWOXgnt3A.

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